Wagoner, Autumn

Wagoner, Autumn is an individual health care provider with primary practice located at 4641 Fulton Dr Nw , Canton OH 44718-2384. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Wagoner, Autumn can be contacted via phone (330) 433-6075.

Contact Information

Primary practice address
4641 Fulton Dr Nw Canton OH 44718-2384
Phone: (330) 433-6075
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X I.2506755 Ohio

Profile Details

NPI number 1962875245
LBN Legal business name Wagoner, Autumn
Credentials LISW
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2015
Last updated Oct 9th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962875245 NPPES
Ohio MEDICAID 0208461
Ohio Other I.2506755

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